Gout - Medtick
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Gout

What is it?

Painful, hot, red, swollen (inflammation condition) that can affect one or more joints.

  • It is caused by the deposits of monosodium urate crystals — which are formed from excess uric acid — in joints and soft tissue.
  • Uric acid is formed from the breakdown of purine nucleotides from internal or ingested sources (see fods below).
  • The deposits of crystals may continue for months or years without causing symptoms and it is only when the crystals are shed into the bursa (small sacs of synovial fluid that surround the joint) that an inflammatory reaction occurs.
  • The shedding of crystals can be triggered by a number of factors including direct trauma, dehydration, rapid weight loss, illness and surgery.
  • Timely and effective treatment of gout is necessary to reduce the risk of flares, chronic polyarthritis (long term arthritis pain in joints) and tophaceous disease [Tophaceous disease occurs when crystals build up under the skin, forming white or yellow lumps (tophi), which can cause permanent damage to the joints].
  • Although prolonged hyperuricaemia (high levels of uric acid) can lead to the development of gout, not all patients with raised serum uric acid levels develop the condition.

The Pharmaceutical Journal, PJ, 23/30 August 2014,Vol 293, No 7824/5;293(7824/5):DOI:10.1211/
PJ.2014.20066136

  • Please note most of our uric acid is excreted and reabsorbed by our kidneys, so if one has a kidney condition this can increase uric acid levels in our blood and in turn may cause gout.
  • It is believed that a lack of uric acid excretion rather than absorption of uric acid by the kidneys  is more like to cause gout.
  • It usually starts with the big toe on the foot (but can occur anywhere).
  • It mainly affects men and women after menopause.
  • It rarely affects young children and young adults.

After a period of many years, the chronic stage of gout may develop.

  • In this stage, the disease has caused permanent damage to affected joints and, occasionally, to the kidneys.
  • When uric acid deposits accumulate in the skin over long periods of time, they form small, rounded lumps (nodules) called tophi.
  • These nodules vary in size, and they are yellow or cream in color. If the tophi become very large, they can erupt through the skin and discharge a chalky, white substance.

The most common locations for tophi include:

  • Rims of the ears
  • Toes and fingers
  • Achilles tendons
  • Elbows and knees

Skinsight.com

Diagnosis Tests

                         Do not use Aspirin to treat gout:
Aspirin reduces the secretion of uric acid via the kidneys and may interact with other gout medications.
High dose ibuprofen may help but must be used in caution due to side effects and/or underlying health reasons and should normally be prescribed by your medical Doctor. Other Non – steroidal anti-inflammatory pain relief medication (NSAIDs) are available via an assessment done by your Medical Doctor.

Cause

Treatments

  • Recent surgery

Syndromes

Food and drink include:

High purine foods include (avoid):

  • Offal – liver and kidneys
  • heart and sweetbreads
  • Game – pheasant, rabbit, venison
  • Oily fish – anchovies, herring, mackerel, sardines, sprats, whitebait, trout
  • Seafood – especially mussels, crab, shrimps and other shellfish, fish roe, caviar
  • Meat and Yeast Extracts – Marmite, Bovril, commercial gravy
  • Beer

Moderate purine foods (eat in moderation) 

  • Meat – beef, lamb, chicken, pork, duck
  • Dried peas, beans and legumes – baked beans, kidney beans, soya beans and peas Mushrooms and microprotein.
  • Some vegetables – asparagus, cauliflower, spinach
  • Wholegrain – bran, oat bran, wholemeal bread

Low purine foods

  • Dairy – milk, cheese, yoghurt, butter
  • Eggs
  • Bread and cereals – (except wholegrain)
  • Pasta and noodles
  • Fruit and vegetables

UK Gout Society

Medication

  • Diuretics (loop and thiazides)
  • Levodopa (Parkinson medication)
  • Aspirin
  • Ciclosporin
  • Cytotoxic medicines
  • Ethambutol
  • Pyrazinamide
  • Ribavarin and interferon
  • Teriparatide

Vitamins, herbals and minerals

  • Vitamin B3 supplements

Symptoms

(Attack of gout can vary from every few weeks to once in a lifetime)

  • Joint stiffness and pain?
  • Joint pain in hands and feet (particularly big toe)?
  • Pain attack occur over 3 hours quickly last from 3 to 10 days and then go back to normal (pain free) and are unpredictable?
  • Inflamed (hot, red and swollen) joints?
  • Red and shiny skin over affected joints?
  • Itchy skin on  affected joints?
  • Dry skin and/or scaly skin and/or rough skin on that affected joint?

Complications /Information to beware of/General tips:

This condition can lead to:

  • Trophi – small white or yellow lumps of crystal under the skin, it can develop anywhere in the body, but usually form on the:
    • Toes
    • Heels
    • Knees
    • Fingers
    • Ears
    • Forearms
    • Elbows
  • Joint damage
  • Osteoarthritis
    • Gout is commonly distinguished from Osteoarthritis by a flare period followed by complete remission between flares.
    • However, long-term damage to joints associated with uncontrolled inflammation in gout (and Rheumatoid arthritis) may ultimately result in the development of Osteoarthritis in the affected joint, making it difficult to distinguish the types of arthritis by symptoms alone.
    • Furthermore, Osteoarthritis often co-exists with gout, resulting in chronic joint pain in the absence of active disease).

Clinical Pharmacist, CP, April 2015, Vol 7, No 3;7(3):DOI:10.1211/PJ.2015.20068288

  • Synovotis
    • The knee, ankle, wrist, elbow, hand, foot, and shoulder are synovial hinge joints, and as such the joint is lined with a synovial membrane.
    • If this membrane becomes inflamed it is called synovitis.
    • It is caused by overuse or trauma and results in repeated bleeds into the joint.
    • If not treated early or correctly the synovial membrane becomes thickened with more blood vessels and becomes swollen and painful.
    • It is also associated with rheumatoid arthritis ,  psoriasis arthritis, lupus and gout.
  • Kidney stones
  • Kidney failure
  • Priapism
  • Prurigo Nodularis

Flare ups and General tips

Flare ups do occur and can range from every few weeks to once in a lifetime

If one has an attack one can:

  • An ice pack or cold compress (not pure ice on the skin – wrap in a cloth) may provide temporary relief of a mild attack.
  • Wrap the ice pack in a thin towel and apply to the joint for only 15 to 20 minutes to prevent frostbite and skin sensitivity especially if one is diabetic and or have neurological conditions.
  • You can do this several times a day.
  • Rest the joint.
  • If the fingers and/or big toe is most often affected, elevate the foot to alleviate the swelling above the heart (one can lie down).
  • Keep off your feet as much as possible, and, if you do need to move about do not put weight on it use a cane or crutches.

Lifestyle changes:

Purines in food — what to eat and what to avoid
High purine foods (avoid) Moderate purine foods
(eat in moderation)		 Low purine foods (eat normally)
Offal – liver and kidneys, heart and sweetbreads

Game – pheasant, rabbit, venison

Oily fish – anchovies, herring, mackerel, sardines, sprats, whitebait, trout

Seafood – especially mussels, crab, shellfish, fish, roe, caviar

Meat and yeast extracts – Marmite, Bovril, commercial gravy, beer

Source: The UK Gout Society

 Meat/poultry – beef, lamb, pork, chicken, duck

Mushrooms and mycoprotein (Quorn)

Dried peas, beans and legumes – baked beans, kidney beans, soya beans, peas

Some vegetables – asparagus, cauliflower, spinach

Wholegrains – bran, oat bran, wholemeal bread

 

 Dairy – milk, cheese, yoghurt, butter

Eggs

Bread and cereals (except wholegrain)

Pasta and noodles

Fruit and vegetables (see moderate purine foods for exceptions)

 
  • Foods such as shellfish, offal and sardines should be avoided, and the intake of soft drinks sweetened with fructose or sucrose should be limited.

Choi HK, Atkinson K, Karlson EW et al. Purine rich foods, dairy and protein intake, and the risk of gout in men. NEJM 2004;350:1093–1103.

  • Dairy products are beneficial in lowering serum uric acid and eating yoghurt on alternate days can help reduce levels.

Choi HK, Atkinson K, Karlson EW et al. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Archives Internal Medicine 2005;165:742–748.

  • Cherries are high in vitamin C and can also help increase uric acid excretion.

Huang HY, Appel LJ, Choi MJ et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis and Rheumatism 2005;52:1843–1847.

  • Moderate physical exercise can be beneficial, but intense muscular exercise should be avoided because it can lead to a rise in uric acid levels.
  • Overweight patients should lose weight gradually, as rapid weight loss can precipitate ketosis and a subsequent rise in urate levels.
  • It is recommended that men restrict their alcohol consumption to less than 21 units per week and men and women have at least three alcohol-free days per week. Beer, stout, port and fortified wines should be avoided.

This condition may show similar symptoms to:

It is not the same and your Medical doctor should rule this condition out before further treatment
Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice

Detailed Information

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